摘要
目的检测初诊多发性骨髓瘤(MM)患者血清中分泌型成熟B细胞表面抗原(sBCMA)表达水平和在治疗过程中的变化,并探索其临床意义。方法回顾性分析2018年8月至2020年9月苏州大学附属第一医院血液科收治的158例多发性骨髓瘤患者的临床资料。通过酶联免疫吸附试验(ELISA)测定患者血清中sBCMA的水平并和正常范围比较,并分析其与临床疗效、年龄、疾病类型、修订的国际分期系统(R-ISS)分期、肾功能、体液免疫功能等指标的关系。结果患者中位年龄57岁(31~73岁),男86例(54.5%)、女72例(45.5%),以IgG型为主,占51.2%(81例)。初诊患者治疗前sBCMA值M(Q1,Q3)为76.50(55.50,94.40)μg/L,100%高于正常值上限(14.5μg/L)。按照疗效评估分为完全缓解(CR)组、较好缓解(VGPR)组、部分缓解(PR)组及无效组,结果显示,CR组[80.10(58.05,96.90)比15.70(9.85,28.65)μg/L]及VGPR组[74.60(52.20,93.00)比17.20(13.30,38.80)μg/L]sBCMA水平较治疗前差异均有统计学意义(均P<0.001),PR组及无效组治疗前后血清sBCMA水平差异均无统计学意义(均P>0.05)。初诊患者血清完整蛋白型M蛋白含量与sBCMA表达水平呈正相关(r=0.22,P=0.040),骨髓浆细胞占比与sBCMA表达无相关性(r=0.07,P=0.449)。初诊时sBCMA水平与MM类型[IgG型、IgA型与轻链型分别为(78.6±3.5)、(72.4±5.4)与(83.8±6.9)μg/L]、年龄[≥65岁比<65岁:(73.6±5.5)比(79.3±3.1)μg/L]、R-ISS分期[Ⅰ、Ⅱ期比Ⅲ期:(80.2±3.1)比(69.4±6.1)μg/L]、肾功能[肌酐清除率(Ccr)≤30 ml/min比Ccr>30 ml/min:(81.6±4.8)比(76.5±3.4)μg/L]及高危核型[高危比标危:(73.6±5.7)比(80.2±3.2)μg/L]均无相关性(均P>0.05)。sBCMA的表达水平与MM患者IgM水平负相关(r=-0.39,P=0.002),而且治疗后sBCMA表达水平与MM患者IgM水平负相关(r=-0.25,P=0.015)。结论MM患者血清中sBCMA表达变化是MM临床判断疗效的可靠指标并且与MM免疫缺陷发生及治疗后恢复相关。sBCMA可作为一种监测和预判MM患者疗效的新的独立标志物。
Objective To explorer Secretory mature B cell surface antigen(sBCMA)expression level,changes during treatment and clinical significance in newly diagnosed MM patients.Methods Clinical data of 158 MM patients admitted to the Department of Hematology,the First Affiliated Hospital of Soochow University from August 2018 to September 2020 were analyzed retrospectively.The concentration of sBCMA in the patients was determined by BCMA ELISA and compared with the normal range.The results were compared with clinical efficacy,age,type,R-ISS stage,renal impairment,and humoral immune function.Results The median age of the patients was 57(31-73 years old),86(54.5%)males and 72(45.5%)females,mainly IgG type,81 patients(51.2%).SBCMA value M(Q1,Q3)was 76.50(55.50,94.40)μg/L,100%higher than the upper limit of normal value.According to the efficacy evaluation,the patients were divided into complete remission(CR)group,very good partial remission(VGPR)group,partial remission(PR)group and ineffiecacy group,the results showed the level of sBCMA in CR group[80.10(58.05,96.90)vs 15.70(9.85,28.65)μg/L]and VGPR group[74.60(52.20,93.00)vs 17.20(13.30,38.80)μg/L]was significantly higher than that before treatment(all P<0.001),and there was no significant difference in PR group and ineffective group before and after treatment(all P>0.05).The amount of serum intact protein M protein was positively correlated with the level of sBCMA expression in newly diagnosed patients(r=0.22,P=0.040),and there was no correlation between the proportion of bone marrow plasma cells and sBCMA expression(r=0.07,P=0.449).The correlation between sBCMA levels at initial diagnosis and MM type[IgG type,IgA type vs light chain type:(78.6±3.5),(72.4±5.4)vs(83.8±6.9)μg/L],age[≥65 vs<65 years:(73.6±5.5)vs(79.3±3.1)μg/L],R-ISS stage[stageⅠ,ⅡvsⅢ:(80.2±3.1)vs(69.4±6.1)μg/L],renal impairment[Creatinine clearance rate(Ccr)≤30 vs>30 ml/min:(81.6±4.8)vs(76.5±3.4)μg/L],and high-risk karyotype[high-risk vs standard-risk:(73.6±5.7)vs(80.2±3.2)μg/L]were not associated(all P>0.05).Expression levels of sBCMA were negatively correlated with IgM levels in MM patients(r=-0.39,P=0.002)and after treatment(r=-0.25,P=0.015).Conclusions The expression of sBCMA in MM patients is a reliable indicator of the clinical efficacy of MM and is related to the occurrence of MM immune deficiency and recovery after treatment.sBCMA can be used as a new independent marker for monitoring and predicting the efficacy of MM patients.
作者
严治
陈广华
姚卫芹
颜灵芝
金松
商京晶
施晓兰
吴德沛
傅琤琤
Yan Zhi;Chen Guanghua;Yao Weiqin;Yan Lingzhi;Jin Song;Shang Jingjing;Shi Xiaolan;Wu Depei;Fu Chengcheng(Department of Hematology,First Affiliated Hospital of Soochow University,Suzhou 215000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2022年第30期2351-2356,共6页
National Medical Journal of China
基金
国家血液系统疾病临床医学研究中心转化研究课题(2020ZKPB01)
苏州市2021年度第十二批科技发展计划医疗器械与新医药——医工结合协同创新研究项目(SLJ2021004)。
关键词
多发性骨髓瘤
分泌型成熟B细胞表面抗原
治疗反应
预后
免疫缺陷
横断面研究
Multiple myeloma
Secretory mature B cell surface antigen
Therapeutic response
Prognosis
Immune deficiency
Cross-sectional study
